Certified hand therapists (CHTs) are specialized physical or occupational therapists who meet standards established by the Hand Therapy Certification Commission (HTCC) which encompass four domains including assessing the patient and specifically their upper limb, determining an individualized plan of care and prognosis, implementing the plan of care, and mastering relevant basic science and upper extremity knowledge. However, these healthcare providers are non-uniformly distributed throughout the United States (US) with geographic- and socioeconomic-based disparities.

To define overall prevalence of CHTs in the US with geographic and socioeconomic sub-analysis and provide an update to research by Stegink-Jansen.

Cross-sectional study.

Zip Code Tabulation Area (ZCTA) of active CHTs were determined using 2024 HTCC registry and cross-referenced for geographic area and population income and race/ethnicity using the 2020 US Census. Cohorts were defined as no CHT (ZCTAs with no CHT) and CHT (ZCTAs with at least one CHT).

The no CHT cohort consisted of 30,277 ZCTAs (228,520,642 people), while the CHT cohort consisted of 3497 ZCTAs (102,928,639 people). The average number of CHTs / ZCTA and CHTs / 100,000 people overall was 0.2 and 2.1 respectively. The predominant disparity was geographic area with the no CHT cohort consisting of 50.9% rural and 49.1% urban ZCTAs, and the CHT cohort consisting of 7.6% rural and 92.4% urban ZCTAs.

The overall prevalence of CHTs remains low despite a recent increase in CHTs. Combined with the increased demand for hand therapy, there is likely a supply-demand mismatch that will make it difficult for patients to access these healthcare professionals. In addition, the disproportionally low prevalence of CHTs in rural geographic locations may lead to suboptimal outcomes.

The purpose of this study was to explore athletes' perspectives on existing US Olympic & Paralympic Committee (USOPC) resources and to identify their recommendations for enhancing future initiatives aimed at promoting Paralympic athlete health, well-being and performance.

Phenomenological qualitative study SETTING: Online.

A convenience sample of 19 Team USA Paralympic athletes 18 years of age or older participated (female n=11; age 31±9 years) representing four categories of conditions recognised by the International Paralympic Committee (muscle and movement, bone-related, visual and central nervous system).

The resulting codebook included 2 themes and 10 corresponding categories. Theme 1, titled Resources for Paralympic Athletes, includes five categories: (1) community-level; (2) university-level; (3) USOPC; (4) National Governing Body and (5) Resources Access, Awareness and Satisfaction. Theme 2, titled Recommendations for Improvements to the USOPC, also included five categories: (1) sports medicine; (2) disability-specific needs and classification systems; (3) sports performance; (4) resources and (5) community awareness. Study participants recognised meaningful improvements in organisational support, including expanded financial assistance and mental-health services yet persistent structural inequities continue to limit equitable access to high-quality resources. Fragmented and geographically uneven sports medicine, coaching and performance infrastructures, along with ongoing challenges in classification transparency and disability-specific programming, remain key barriers to athlete development.

Findings highlight the need for decentralised clinical and performance networks, enhanced evidence-based classification practices and more robust transition planning from collegiate to elite settings. Including athlete perspectives and strengthening equitable resources creates more accessible, consistent and performance-optimising environments within the US Paralympic system.

Rates of adolescents and young adults (AYAs) reporting poor mental health have increased, with symptoms of anxiety and depression being most common. Yet, the processes underlying these trends remain unclear. This cohort study aims to establish a comprehensive dataset combining data from multiple sources (surveys, behavioural tests, registers and smartphone sensors) to assess mental health, including mental ill-health and well-being. The dataset will enable analyses of prevalence, risk and protective factors and predictive modelling of mental health trajectories. The study also evaluates the feasibility of such longitudinal data collection among AYAs.

This study recruits 2000 AYAs aged 15-29 years from the general population in Sweden using an initial random sample invited by post, followed by recruitment through digital channels. Participants are followed for 2 years under one of three protocols: annual assessments, bi-annual assessments and annual assessments complemented by repeated ecological momentary assessments. Across protocols, data are collected through surveys using a study-specific mobile app and digital behavioural tests. Demographic and clinical information, including psychiatric diagnoses and prescribed medications, are obtained through national health registers. Smartphone sensor data are collected for insights into phone usage, sleep patterns and mobility. Blood samples are collected from a subset via home-based testing to enable biomarker analysis. When applicable, machine learning, including deep learning techniques, is applied to develop predictive algorithms for mental health outcomes, with the potential to inform early identification and prevention. Feasibility outcomes include recruitment and retention rates and the acceptability of study procedures and measures, assessed to inform future studies.

Representatives from the target population have contributed to the study's development. The study complies with General Data Protection Regulation (GDPR) and has been approved by the Swedish Ethical Review Authority. Findings will be disseminated through scientific publications, conferences and to the public and relevant organisations.

Youth with diverse sexual orientations, gender identities and/or expressions, and sex characteristics (SOGIESC), including those who are lesbian, gay, bisexual, transgender, intersex, queer/questioning, nonbinary, or asexual/aromantic (LGBTIQNA+) face elevated mental health risks linked to stigma and discrimination. In Thailand, quantitative evidence on these disparities is growing, yet qualitative research, particularly on protective factors and resilience mechanisms, remains limited. This descriptive qualitative study explored risk and protective factors shaping mental health and well-being among SOGIESC-diverse youth nationwide. Using purposive maximum-variation sampling guided by an identity-region grid, we conducted semi-structured online in-depth interviews, informed by minority stress theory and socio-ecological perspectives, with 38 LGBTIQNA+ youth aged 15-24 across six Thai regions. Data were analyzed using thematic analysis. Five recurrent risk contexts were identified: 1) family rejection and violence, 2) interpersonal and structural school-based victimization, 3) pressure to conceal identity and restrict gender expression, 4) internalized sexual and gender stigma, and 5) religion-based rejection. Protective processes operated across six levels, including 1) affirming family relationships, 2) supportive peers and teachers, 3) empowerment through self-expression and advocacy, 4) access to role models and community (including online networks), 5) youth-friendly and affirming mental health care, and 6) inclusive school or university policies. Findings highlight a patterned linkage between distal and proximal stressors, counterbalanced by multi-level protective processes. Improving LGBTIQNA+ youth mental health in Thailand requires coordinated action across families, schools, communities, services, and policy, centering youth voices to strengthen context-specific pathways to durable resilience.

Migrant agricultural workers (MAW) play a central role in sustaining Spain's agricultural labor markets, yet they remain disproportionately exposed to precarious working and living conditions with implications for health and healthcare access. This study explored self-reported health status, healthcare access, and healthcare utilization among MAW in Spain.

This study adopted a participatory mixed-methods design and recruited MAW using purposive sampling to participate in questionnaires and semi-structured interviews. Quantitative data were analyzed using descriptive statistics and between-group comparisons, while interviews were analyzed using reflexive thematic analysis.

Participants reported good overall health and formal healthcare access, with 88.5% of the questionnaire participants (n = 400) holding a healthcare card and 76.3% having a general practitioner. However, qualitative findings (n = 30) highlighted negative health impacts of agricultural work and mental health concerns linked to migration-related stressors. Although only 10.5% of participants reported barriers to healthcare access, difficulties obtaining appointments, long travel distances, lack of transportation, and financial constraints were reported. Utilization of occupational health physicians was limited (6.3%), and most workers reported no entitlement to paid sick leave. Healthcare access was unevenly distributed, with women contracted in Morocco reporting more barriers (44%; n = 25). Finally, healthcare visits were sometimes used strategically to obtain administrative proof for residency procedures as well as to obtain care.

While MAW reported generally good health and widespread use of primary and emergency care, important disparities persist in access to occupational health services and in how different subgroups navigate the healthcare system. These findings highlight the need for targeted interventions addressing structural and employment-related barriers.

Suicide-related loss in close relations may lead to complicated grief and increase individual suicide risk. In Kalaallit Nunaat (Greenland), 60% of the population has lost a family member or a close friend to suicide. The study aimed to investigate the association between suicide-related loss of a close family member before the age of 10 and later suicide incidence. The study was a nationwide study using data from the central population register and register of causes of death including 25 663 individuals born between 1983 and 2012. Exposure was the loss of a mother, father, or one or more siblings before the age of 10 and outcome was suicide. Follow-up started at age 10 until the time of death, 40th birthday, or the study termination on 31 December 2022. Incidence rates and incidence rate ratios (IRR) were calculated using Poisson regression. Suicide-related loss of a mother was associated with the highest IRR of 3.4 (95% CI: 1.6-7.2). Suicide-related loss of a father was associated with an IRR of 1.9 (95% CI: 1-3.4), while suicide-related loss of one or more siblings was associated with an IRR of 2.4 (95% CI: 1.3-4.3). Transgenerational suicide transmission was identified in individuals who lost a close relative before the age of 10, with the highest IRR for loss of a mother. The high prevalence of suicide-related loss survivors stresses the need for public health strategies to ensure culturally relevant support.

Disrupted excitation-inhibition (E/I) balance involving GABA and glutamate (Glu) is implicated in the pathophysiology of depression. Ketamine, an NMDA receptor antagonist with rapid antidepressant properties, may modulate this balance, yet proton magnetic resonance spectroscopy (¹H-MRS) studies report inconsistent findings regarding the direction, magnitude, and timing of neurochemical effects. Static ¹H-MRS metabolite concentrations, however, do not directly index neuronal excitation or inhibition; the E=Glx/Glu and I = GABA framework adopted here, as used commonly in the field, is an assumed convention rather than a validated physiological equivalence. We conducted a systematic review and meta-analysis evaluating ketamine's influence on GABA, Glu, and Glx levels and their relationship to clinical outcomes in adults with depression. Multiple databases were searched from inception through October 16, 2025; of 1046 identified studies, 11 met inclusion criteria. Included studies demonstrated significant methodological variability across infusion protocols, metabolite selection, MRS acquisition timing, and brain region of interest. Meta-analyses from limited evidence base did not demonstrate statistically significant treatment-related alterations in any metabolite. The anterior cingulate and prefrontal cortices were most frequently examined regions. The quality of included studies was generally good, despite methodological heterogeneity. One RCT found percent reduction in Glx/GABA ratio positively correlated with symptom improvement. Only a few studies examined ketamine blood levels relative to metabolite changes. Current ¹H-MRS evidence does not confirm significant ketamine-related neurochemical alterations, likely reflecting methodological heterogeneity in timing, acquisition techniques, and brain regions examined rather than a true absence of effect. E/I balance shows promise as a treatment response predictor. Rigorous RCTs with standardized protocols, larger sample sizes, uniform dosing, and systematic biomarker investigations are needed to clarify ketamine's neurochemical mechanism and optimize ketamine's clinical application in treatment-resistant depression.

The methods used to ascertain and categorize race and ethnicity in clinical research influence study design and may influence the interpretation and comparability of findings between studies. Use of inconsistent approaches across the literature may contribute to heterogeneity of findings, with some methods suggesting patterns not representative of underlying processes. This study aimed to systematically review methods used to ascertain race and ethnicity, evaluate systems of racial and ethnic categorization, and comparatively evaluate methods of ascertainment and categorization of race and ethnicity used in clinical research.

An umbrella review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for umbrella reviews and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) statement. We searched five databases (Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, and Sociological Abstracts) from January 2002 to April 2025 using terms related to race and ethnicity, conceptualization, genetics, and clinical research. English-language review articles published in peer-reviewed journals were reviewed by at least two reviewers. Titles, abstracts, and full text articles were screened, and references of selected articles and grey literature. Data were abstracted using a standardized form, and further analyzed and summarised. A nonsystemic, purposive, environmental scan of the grey literature was included to capture representative examples of documents related to the study objectives.

The search generated 12,783 articles, with 139 review articles included. We identified six methods for the ascertainment of race and ethnicity: self-report, social assignment, name-based ethnic classification, geographic assignment, ancestry, and use of multimethod strategies. Twenty-one systems of categorization were identified, with racial categories ranging from 3 to 15. Terminology and systems of categorization varied both within and across geographic regions, reflecting population-specific contexts.

Self-report is the most common method of ascertainment; however alternative methods can be considered when self-reported data are not available. These methods capture different dimensions of race and ethnicity and should be selected and interpreted based on the research question and study context, rather than viewed as interchangeable. The variability in the categorization and terminology used for race and ethnicities suggests the need for informed use of these constructs, to support appropriate contextualization and interpretation of results. Improved methodologic consistency in the use of race and ethnicity is essential to strengthen the rigor of clinical research.

While psychotherapy is established as an overall effective treatment of depression, a significant part of patients does not achieve adequate response. Understanding the neurobiological mechanisms underlying psychotherapeutic change may inform intervention optimization. This study examined changes in neural processing of personally relevant affective memory in individuals with depression following psychodynamic psychotherapy.

Twenty-five individuals with depression and 28 healthy controls underwent functional magnetic resonance imaging (fMRI) scanning at baseline and after six months. Depressed participants received weekly psychodynamic psychotherapy. During fMRI, participants recalled idiosyncratically meaningful affective memories cued by pictorial cues. Region-of-interest analyses examined therapy-related changes in neural activation across areas involved in emotion and memory processing, and social cognition. Seed-to-voxel analyses assessed changes in functional connectivity between those areas.

Following six months of psychodynamic psychotherapy, depressed individuals showed significantly increased activation in the right temporoparietal junction (TPJ) when recalling personally relevant affective memories compared to controls. Functional connectivity analyses revealed decreased coupling between bilateral amygdala and bilateral TPJ in the depressed group post-treatment.

Psychodynamic psychotherapy may increase neural processing in regions supporting mentalizing and the evaluation of personally relevant relational memories. Decreased amygdala-TPJ connectivity suggests reduced automatic affective response during affective memory processing. Findings need to be interpreted in light of the absence of a clinical control group and require replication.

Major depressive disorder (MDD) features widespread cognitive impairments, some pre-existing before onset. However, the causal associations between MDD and multidimensional cognitive impairments, and the structural and functional neural underpinnings mediating these relationships, remain to be elucidated.

We integrated summary-level data from large-scale genome-wide association studies of MDD, cognitive impairments, and neuroimaging phenotypes. Bidirectional mendelian randomization (MR) explored causal associations between MDD and cognitive impairments, with two-step MR assessing neuroimaging phenotypes as mediators.

MR analyses revealed bidirectional causal relationships between MDD and cognitive impairments. Specifically, MDD exerted causal effects on Trail Making Test Part B performance, assessed by the duration to complete the alphanumeric path (β = 0.25, 95% CI 0.05 to 0.45, P = 0.016), and Pairs Matching task performance, assessed by the number of incorrect matches in round (β = 0.11, 95% CI 0.06 to 0.16, P = 2.17 × 10^-5). These associations were partially mediated by brain structural and functional measures, including aparc-DKTatlas_lh_area_medialorbitofrontal (16.00%), IDP_T1_FAST_ROIs_R_mid_front_gyrus (18.18%), and rfMRI connectivity (ICA100 edge 645) (27.27%). Conversely, the duration to complete the alphanumeric path (OR = 1.77, 95% CI 1.30 to 2.40, P = 2.48 × 10^-4) and the number of incorrect matches in round (OR = 2.10, 95% CI 1.43 to 3.07, P = 1.48 × 10^-4) also causally influenced MDD. However, no significant mediation through macro-scale brain imaging phenotypes was observed.

This study provides evidence for potential bidirectional causal relationships between MDD and impairments in executive function and visual memory. The effect of MDD on these cognitive domains may be partially mediated by specific neuroimaging phenotypes.